NPIMap

Organization Active NPI

Clinicas de Salud del Pueblo, Inc.

Doing business as Innercare

  • Federally Qualified Health Center (FQHC)
  • Winterhaven, CA
National Provider Identifier
1124109202
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
090000594 Issued in CA
Legal business name
CLINICAS DE SALUD DEL PUEBLO, INC.
Doing business as
Innercare
Innercare - Winterhaven
WInterhaven Health Clinic
Practice address
2133 Winterhaven Drive
Winterhaven, CA 92283
Phone
(760) 572-2700
Fax
(760) 572-2255
NPI assigned
Oct 17, 2006
Last updated
Feb 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Yvonne Bell, MBA
Title
Ceo
Phone
(760) 344-9951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 090000594 CA Primary

Addresses

Primary practice location

2133 Winterhaven Drive
Winterhaven, CA 92283

Mailing address

852 E Danenberg Dr.
El Centro, CA 92243
Phone (760) 344-9951

Other identifiers 2

IdentifierTypeStateIssuer
FHC70749FMedicaidCA
HAP70749FOtherCAFAMILY PACT

Other names 3

  • Innercare Doing business as
  • Innercare - Winterhaven Doing business as
  • WInterhaven Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040123000551 CA Part A Provider - Federally Qualified Health Center (FQHC) 5496657082 Practice locations: Winterhaven, CA
O20071201000158 CA Part B Supplier - Clinic/Group Practice 5496657082 Receives reassigned benefits from 148 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winterhaven, CA; Salton City, CA; Niland, CA; Mecca, CA; Indio, CA; El Centro, CA; Hemet, CA; Blythe, CA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124109202. Details of each certification follow.

Federally qualified health center certification: CCN 551881

Legal name
CLINICAS DE SALUD DEL PUEBLO INC
Doing business as
WINTERHAVEN HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 10, 2001
Last certification
Jan 10, 2001
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 1970 in CA
Enrollment address
2133 Winterhaven Dr
Winterhaven, CA 92283

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1013544Clinicas de Salud del Pueblo2133 Winterhaven Drive, Winterhaven, CA 92283Certificate of waiverJun 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Brawley Health CLN17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

233 W Cole Blvd
Calexico, CA 92231
Phone (760) 357-2020

50249 Harrison St
Coachella, CA 92236

1023 E Florida Ave
Hemet, CA 92543
Phone (951) 599-8403

1053 W Florida Ave
Hemet, CA 92543

676 Base Line Rd
Ste RT1
Winterhaven, CA 92283

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shirley Chronister Individual Corporate DirectorBoard Member Jan 1, 2015
Leticia de Lara Individual Corporate DirectorBoard Member Jan 1, 2017
Georgina Montano Individual Corporate DirectorBoard Member Jan 1, 2016
Raymond Leon Individual Corporate DirectorBoard Member Jan 1, 2015
Elizabeth Moreno Individual Corporate DirectorBoard Member Jan 1, 2016
Yvonne W Bell Individual Corporate DirectorBoard Member Jan 1, 2007
W-2 Managing EmployeeCeo Mar 19, 2015
Isidoro Romero Individual Corporate DirectorBoard Member Jan 1, 2016
Maria D Lopez Individual Corporate DirectorBoard Member Jan 1, 2015
Nidia Carranza Individual Corporate DirectorBoard Member Jan 1, 2014

Practitioners & affiliated clinicians

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 78

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1124109202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 E DANENBERG DR.",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "92243",
            "telephone_number": "760-344-9951",
            "fax_number": "760-344-5840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 WINTERHAVEN DRIVE",
            "city": "WINTERHAVEN",
            "state": "CA",
            "postal_code": "92283",
            "telephone_number": "760-572-2700",
            "fax_number": "760-572-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DE SALUD DEL PUEBLO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-344-9951",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "090000594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70749F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PACT",
            "identifier": "HAP70749F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innercare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innercare - Winterhaven",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WInterhaven Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WInterhaven Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winterhaven, CA

Sources for this page

Verify at the official NPI Registry.